Laparoscopic radical nephrectomy: financial disincentives by the Health Care Financing Administration

Laparoscopic radical nephrectomy is a minimally invasive alternative to open radical nephrectomy. We have noticed that since the beginning of 2001, when the Current Procedural Terminology (CPT) code 50545 became available for laparoscopic nephrectomy, the reimbursement for the laparoscopic operation was significantly lowered. This led us to survey 25 laparoscopic urologic surgeons to assess trends in reimbursement from all over the United States. During this period, the records of reimbursements for radical nephrectomy were available from a single practice to compare that for the open and laparoscopic techniques. The 19 open and 10 laparoscopic operations were entered in a database for statistical analysis. Endourologists around the country also were polled on the subject. The average reimbursement for an open radical nephrectomy was $1581 +/- 325 (SD), while the average reimbursement for a laparoscopic radical nephrectomy was $1192 +/- 184. Twenty-five polled endourologists had noted similar reductions in reimbursement for laparoscopic procedures. Many of those polled had participated in the Specialty Society Relative Value Unit (RVU) survey for laparoscopic radical nephrectomy and stated that their recommendations were that the value be considered greater than that of the open counterpart. The highly significant difference in reimbursement reflects a financial disincentive to surgeons performing laparoscopic procedures. It is obvious that in the U.S., the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) is devaluating all surgical procedures, and financial pressures of this type are disturbing.